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General NPI Number Information
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NPI Number | 1174737886
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Entity Type | Organization
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Legal Business Name | TARBORO CLINIC OPTICAL
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 2807 N MAIN ST
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City | TARBORO
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State | NC
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Zip | 27886-1903
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Country | US
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Telephone | 252-823-8295
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CLINIC DR
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City | TARBORO
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State | NC
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Zip | 27886-1935
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Country | US
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Telephone | 252-823-2105
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Fax | 252-823-3164
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. JANET WEBB
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Credential |
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Telephone | 252-823-2219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1077
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License Number State | NC
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